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Annals of Nursing and Practice
Case Report *Corresponding author
BibiHajira, Shifa College of nursing, Shifa Tameer-e-

Application of Orem Self Care Millat University Sector H 8/4 Islamabad, Pakistan, Tel:
03-365888349; Email:

Deficit Theory on Psychiatric

Submitted: 10 May 2018
Accepted: 01 June 2018
Published: 03 June 2018

Patient ISSN: 2379-9501

Copyright
© 2018 Irshad Ali
Bibi Hajira Irshad Ali*
Keywords
College of Nursing, Shifa Tameer-e-Millat University, Pakistan
• Nursing system; Nursing agency; Self-care demand;
Self-care agency
Abstract
Theoretical framework always guides nursing practice and nurses follow the concepts
from theoretical framework unconsciously. This paper highlights the applicability of
Dorothea Orem’s theory in a psychiatric patient. Dorothea Orem has identified the role
of a nurse and an individual who need nursing care that she called as Self-Care Deficit
Nursing theory. Orem has defined different concepts and each aspect is explained in
detail. She tried to explain the role of nurse by mentioning terms such as nursing system
(wholly compensatory, partly compensatory, supportive and educative system) and
nursing agency (abilities). She defined sick patient as self-care deficit who have fewer
agencies (abilities) and more demands (universal, developmental, health related and
therapeutic). The paper will describe the usability of theory into practice that resulted
in drastic change in practice and patient’s early recovery.

ABBREVIATIONS mood anhedonia, hopelessness and suspiciousness. Presently he

was complaining about restlessness, irritability, irrelevant talk,
SCDNT: Self-Care Deficit Nursing Theory; OPD: Out Patient urinary and fecal incontinence and poor oral intake. According
Department to the verbatim “At night I tried to kill myself. I sit alone in my
INTRODUCTION room”.

There is a point in an individual’s life where he is not able
to cope up with the stressors and confine oneself in a box from
which it is a difficult challenge for a person to come out of the
trap. In such circumstances a person lacks interest in taking care
of own self. This makes the person wholly or totally dependent
on the care giver. Here, a nurse plays a major role to take care of
that patient by providing basic to supportive care [1]. A similar
scenario happened in clinical setting in which Orem’s theory is
fully incorporated into practice that resulted in positive changes
on an individual’s health which helped the patient to accept the
reality and to become responsible for his own health and related
concerns. The importance of this theory is to take care of the
patient at correct time with appropriate decision so patient can
recovery rapidly with decrease hospital stay.
CASE PRESENTATION
A 36 year old male patient was referred from OPD to psychiatric
ward. He lives in a nuclear family. He has 3siblings and he is the
elder one, he is divorced, belonging to middle socioeconomic
status. He is educated till masters. His comorbid personality was
social and cooperative. He is not addicted to any drugs. He was
having psychiatric problem since 4 years and he was diagnosed
as schizoid Personality Disorder. He had complained of low
The patient had four suicidal attempts in past. The first time
was in 2015 when he opened gas chamber in his room and laid
down on his bed for 6 hours. But nothing happened so he tried
again for the second time in September 2016 when he went to
a residential area and asked the security guard to shoot him by
telling him that he was an agent. Third time he jumped in lake but
all of the attempts was failed. Fourth time he planned to attempt
again in January 2018 by cutting the vein on his wrist but he
was still alive so then he drank Hydrogen peroxide (H2O2) which
resulted in severe abdominal pain and then he was admitted to
hospital for stomach watch. The patient reported that after his
suicidal attempt he felt relaxed and satisfied. He had drastic
events in his life which he mentioned later on the interview. He
reported that he is homosexual and he had a relationship with
one of his friends to whom he shared hugs and kisses but no
other sexual intercourse. In an event in which he reported that
one of his friend to whom he has sexual relationship betrayed
him by making a sexual video that was rowed on social media in
2013 that laid him into tears and he was shattered.
DISCUSSION
Humans strive to remain alive and to function smoothly
by engaging in continuous communication and interchanging

Cite this article: Irshad Ali BH (2018) Application of Orem Self Care Deficit Theory on Psychiatric Patient. Ann Nurs Pract 5(1): 1093.

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information between themselves and their environment. In
humans, the power of spontaneous and deliberate action is used
to identify their basic needs and to make appropriate judgments
[2]. Furthermore, human beings care for own-self and others
through function regulating actions in order to achieve optimum
level of health. Human agency is responsible to discover,
develop, and disseminate the ways to identify individual needs
and make inputs into self and others to fulfill the identified
needs. Groups of human beings with structured relationships,
cluster tasks and duties are responsible to provide care to the
members who are in need. Especially, the ones who have some
needs which require deliberate decisions about self and others.
General theory of nursing is correctly referred as self-care deficit
nursing theory which includes four other theories. There are
six primary concepts and peripheral concepts in the Self Care
Deficit Nursing Theory (SCDNT) [3]. The concepts are self-care/
dependent care, self-care deficit/dependent care deficit, self-care
agency/dependent care agency, therapeutic self-care demand/
dependent care demand, and two concepts related to nurse that
are nursing systems and nursing agency. Self-care is the initiation
of activities by an individual to maintain his own life, achieve
optimum level of health and improve well-being. Self-care Agency
is an individual’s ability to involve in self-care and it is affected
by the basic conditioning factors. The basic conditioning factor
is peripheral concept that is related to both the self-care agent
and also to the nurse. It includes age, gender, developmental and
health state, health care and family system, patterns of living,
environmental and sociocultural factors, and the availability
and adequacy of the required resources. Therapeutic self-care
demand is the total self-care actions performed for some time
period aiming to meet known self-care requisites by using
appropriate methods and associated sets of actions. Self-care
Appendix A The self-care agency and self-care demands are important contributors to maintain well-being of an individual. Increase in self-care
demands require nursing agency to work for the patient to help an individual to achieve self-care. Conditioning factors (age and gender) effect the
functioning of self-care agency.
Ann Nurs Pract 5(1): 1093 (2018)
Irshad Ali (2018)
Email:
deficit is a state where nursing is required. Nursing is required
when an adult (in the case of a dependent for example: child,
parents or grandparents) incapable of or limited effective self-
care by own-self. Nursing agency is a complex property of a person
who is educated and well trained nurse who allows the patient to
know, to identify and to help them meet their therapeutic self-
care demands by developing their own self-care agency. Nursing
system includes the relationship of a nurse and a patient having
wholly compensatory system, partly compensatory system and
supportive-educative system. This system is activated when the
client’s therapeutic self-care demand increases as compare to the
available self-care agency which results in the need of nursing.
In addition, Orem’s self-care theory is the constituent of several
requisites. Following are the requisites of Self-care: universal (air,
water, food, rest, solitude and social interaction), developmental,
health deviation and therapeutic [4]. A model provides a clear
guidance for the concepts and their relationships given by Orem
[5]. In the model, self-care agency and self-care demand are
interrelated to each other. Conditioning factors (age and gender)
impact on self-care agency (abilities). If self-care agency will
be weak then self-care demand (need of an individual) will be
more. Hence, there will be a need of nursing agency or nursing
system to look after an individual. The conceptual model helps
to conceptualize the association and relation between the
components (Refer Appendix A).
INTERVENTION
By applying the Orem’s theory in the aforementioned scenario
the patient required wholly compensatory care as his abilities
were less and he was unable to fulfill his activities of daily living
on his own. Slowly and gradually he was able to care for himself
with the supportive and educative system. In the light of orem’s
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theory patient’s needs were identified and then interventions
were planned accordingly. Different strategies were performed
like offereing counseling and teaching sessions that motivated
him to think differently. Moreover, vocational therapy was also
arranged and the patient was engaged in group therapy in order
to make him comfortable while socializing with others. Different
interventions were implemented on the patients like counseling
and teaching sessions were offered that motivated him to think
differently. Moreover, the patient was also engaged in vocational
and group therapy in order to make him comfortable while
socialization. It helped to care for the patient in a way which
resulted in positive outcomes in the patient. He was given
cognitive behavioral therapywhich helped him in problem
solving. Patient in the beginning was isolated and wanted to be
in the room alone. For that, frequent sessions were arranged to
encourage the patient to verbalize his feelings. The interventions
helped the patient to move from wholly compensatory to partially
compensatory and he was able to do his activity of daily livings
with minimal help. Furthermore, several activities like one to one
session, group therapy, sharing of personal thoughts in a group,
ludo and physiotherapy sessions were arranged which overall
helped the patient to improve his condition.
Cite this article
Irshad Ali BH (2018) Application of Orem Self Care Deficit Theory on Psychiatric Patient. Ann Nurs Pract 5(1): 1093.
Ann Nurs Pract 5(1): 1093 (2018)
Irshad Ali (2018)
Email:
CONCLUSION
Dorothea Orem’s theory is highly applicable in the clinical
setting and it helps nurses to improve patient’s health by making
them independent. A nurse can assist in the speedy recovery of
the patient by incorporating theoritical concepts into the practice.
There must be program for homophile for fullfilling there needs
and desire as its illegal in Pakistan.
REFERENCES
1. Grando VT. A self-care deficit nursing theory practice model for
advanced practice psychiatric/mental health nursing. Self-Care,
Dependent Care, & Nursing. 2005; 13: 4-8.
2. Hohdorf M. Self-care deficit nursing theory in Ingolstadt-An approach
to practice development in nursing care. Self-Care, Dependent-Care &
Nursing. 2010; 18: 19-25.
3. Norwood BR. The integration of a program of structured simulation
experiences in a SCDNT based curriculum. Self-Care, Dependent-Care,
and Nursing. 2008; 16: 22-24.
4. McEwen M, Wills EM. Theoretical basis for nursing. Lippincott
Williams & Wilkins. 2017.
5. Smith MC, Parker ME. Nursing theories and nursing practice. FA Davis;
2015.
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